{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:42Z","timestamp":1787815122215,"version":"build-2784847793"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The cardiovascular\u2013kidney\u2013metabolic (CKM) framework and metabolic dysfunction\u2013associated steatotic liver disease (MASLD) describe a shared clinical continuum, but the prognostic value of joint fatty liver index (FLI)\u2013NAFLD fibrosis score (NFS) phenotypes across CKM stages is uncertain. We analyzed 10 National Health and Nutrition Examination Survey cycles (1999\u20132018) linked to mortality through 2019. Among 31,317 adults, participants were classified as A (no MASLD\/NFS\u2010low), B (MASLD\/NFS\u2010low), C (no MASLD\/NFS\u2010high), or D (MASLD\/NFS\u2010high) and stratified by operational CKM Stages 0\u20134. Survey\u2010weighted survival analyses and Cox models incorporated 20\u2010imputation covariate analysis; exposure, outcome, follow\u2010up, and survey\u2010design fields were not imputed. During 291,392.5 person\u2010years, 4284 all\u2010cause and 1417 cardiovascular deaths occurred. All\u2010cause survival differed across phenotypes in Stages 2\u20134 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001 for each), but not between A and B in Stage 1 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.695). At Stage 2, adjusted D\u2010versus\u2010A hazard ratios were 1.57 (95% CI 1.30\u20131.91) for all\u2010cause mortality and 2.09 (1.57\u20132.79) for cardiovascular mortality; corresponding Stage 4 estimates were 1.44 (1.21\u20131.70) and 1.25 (0.96\u20131.64). The full stage interaction was non\u2010estimable, and supported\u2010stage interaction\n                    <jats:italic>p<\/jats:italic>\n                    values were 0.113 and 0.122. Joint\u2010phenotype associations varied across supported CKM stages, but sparse early\u2010stage phenotypes, a small apparent discrimination gain, and nominal subgroup findings support external validation rather than immediate clinical deployment.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70285","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:42:36Z","timestamp":1787812956000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stage\u2010Dependent Prognostic Value of the Joint\n                    <scp>MASLD<\/scp>\n                    \u2013\n                    <scp>NAFLD<\/scp>\n                    Fibrosis Score Phenotype Across the Cardiovascular\u2013Kidney\u2013Metabolic Syndrome Continuum: A Retrospective\n                    <scp>NHANES<\/scp>\n                    Cohort Analysis, 1999\u20132018"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4608-9757","authenticated-orcid":false,"given":"Yi\u2010Fei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun\u2010Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010Peng","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7212-6203","authenticated-orcid":false,"given":"Rong\u2010Hui","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze\u2010Ping","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui The First Affiliated Hospital of Anhui Medical University  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001184"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.6892"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.06.003"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000004"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.05.013"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00308-3"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.07.035"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322786"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15660"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-022-01483-y"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.12.022"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330595"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-6-33"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21496"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.11.013"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.036"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-019-05024-3"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.050"},{"key":"e_1_2_11_20_1","volume-title":"National Health and Nutrition Examination Survey: Weighting Module","author":"National Center for Health Statistics"},{"key":"e_1_2_11_21_1","volume-title":"Public\u2010Use Linked Mortality Files","author":"National Center for Health Statistics"},{"key":"e_1_2_11_22_1","volume-title":"Public\u2010Use Linked Mortality File Data Dictionary","author":"National Center for Health Statistics","year":"2019"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.04.031"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000323"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4085"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"e_1_2_11_29_1","volume-title":"NHANES 2017\u20132018 Data Documentation, Codebook, and 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